Cancer patients tend to develop several secondary conditions due to the treatments and a lack of physical activity. These secondary conditions include severe fatigue, atrophy, joint restrictions, lymphedemas and osteoporosis to name just a few.[i]
Although those are inevitable side effects of the illness and the treatments, most people don’t realize that these conditions can be efficiently managed with physical therapy.
Oncologic Physical Therapy (PT) still remains an underexplored subdomain of PT although it can be highly beneficial for many cancer patients.
In this article, we’ll explore what Oncologic PT is, what physical therapists do in oncology and some research that signifies the importance of this field.
What is Oncologic Physical Therapy?
Physical therapy for cancer patients is called Oncologic Physical Therapy. You can benefit from these treatments whether you’re currently going through chemotherapy and radiation, if you’re in remission or if you’re suffering from advanced cancer and looking for end of life care.
Oncologic physical therapists work in different settings. These include acute care, in-patient oncology wards in the hospitals, outpatient rehab for patients in remission, palliative care centers and home healthcare.
Several studies have shown that a well-designed physical therapy regimen can positively influence activity expectations and self-efficacy in cancer patients.[ii]
An observational study by Johnsson et al. (2019) concluded that both endurance and resistance training help combat some of the chemotherapy-related side effects in women battling breast cancer.
They found that 26 endurance exercise sessions and 31 resistance training sessions improved energy, reduced stress and nausea. [iii]
Physical exercise can also reduce depressive symptoms in cancer patients, although the reduction is small.[iv] Exercise that is supervised and lasts longer than 30 minutes tends to produce a bigger reduction in depressive symptoms.[v]
What Do Oncologic Physical Therapists Do?
The primary goals of Physical Therapists in Oncology are to maximize wellness and improve your quality of life.
Some other roles of Oncologic Physical Therapists include:
- Conducting a detailed assessment of the patients to determine the baseline wellness levels and identify areas for improvement.
- Plan out appropriate exercise programs around the patient’s current functional status to improve mobility, decrease fatigue and target painful or pathological conditions.
- Provide palliative care to end of life patients.
- Return patients to regular function and restore stamina and body strength after the end of chemotherapy or radiation therapy.
- Educate patients and caregivers about the detrimental effects of going without physical activity during and after cancer treatments. And elaborate on the post-treatment home exercise/ physical therapy plan of care.
Most Common Conditions Treated by Oncologic Physical Therapists
The conditions we treat here are mostly side effects of chemotherapy, surgery and limited activity seen in cancer patients. Here are some of them:
1. Lymphedema
This is the accumulation of fluid in your soft tissues due to the malfunctioning lymphatic system. It leads to swelling in different parts of your body such as the head, neck, hands or legs. Lymphedema is recognized as one of the leading side effects of cancer treatments.[vi]
2. Palliative Care
Hospice or palliative care is a big part of Oncologic PT. Here physical therapists use a combination of various treatments to decrease pain and discomfort. These can include exercise therapy, massage therapy, compression bandages and TENS. This is often targeted at patients with advanced cancers to improve their quality of life.
3. Cardiovascular Issues
Cardiomyopathy, arterial disease, HTN and metabolic issues can result from cancer treatments. Other than that, a prolonged reduction in physical activity and a sedentary life can cause cardio-pulmonary weakness which is aggravated by treatment-related toxicities.
4. Fecal and Urinary Incontinence
Treatment of prostate and bladder cancer such as cystectomy or bilateral pelvic lymph node dissection often leads to faecal and urinary incontinence.[vii] This can significantly reduce your quality of life.
Quick tip:
Incontinence is when you can’t control over unination or defecation.
5. Scar Tissue Adhesions
Some forms of cancer such as ovarian and skin cancer can produce scar tissue inside your body. These tissues tend to form adhesions resulting in pain and further complications.[viii] Physical therapists use different modalities to resolve the adhesions and decrease the scar tissue to improve flexibility and ROM of different areas.
6. Neuropathy and Balance Issues
Neuropathy is a disease of the peripheral nerves that leads to numbness. Some cancer treatments tend to damage your nerves.[ix] Damage to the lower limb nerves can cause serious balance issues.
7. Fatigue and Generalized Weakness
Weakness is one of the most common side effects of cancer. The pathophysiology of cancer-related fatigue is still not clear but it could have to do with cytokine dysregulation and circadian rhythm disruption. [x]
What Treatments Do Physical Therapists Use in Oncology?
None of the treatments that physical therapists use in oncology is specific to this field. All of these approaches are widely applied in other areas of PT as well.
Your physical therapist will base your treatment regimen on what your initial assessment results were so these techniques, although widely used, are not applied for every cancer patient.
Oncologic Physical Therapy interventions don’t only include exercise. Here are some of the treatments we give to cancer patients:[xi]
1. Stretching to Improve ROM and Flexibility
Cancer patients are inactive during their treatments and even afterwards due to extreme fatigue. This leads to tightness, stiffness and loss of ROM in several areas.
Surgeries such as mastectomy can also cause adhesions in the muscles and so a stretching program benefits such patients.[xii]
Stretching also improves the blood flow and hence oxygen to an area. That’s why this is included in almost all treatments sessions in Oncologic Physical Therapy.
Your physical therapist will stretch different areas of the body such as the head and neck, shoulder, back, hips and legs. Depending on the results of your initial assessment your physical therapist might focus on some areas more than others.
2. Gait and Balance Training
Neuropathy is often the leading cause of gait and balance problems after chemotherapy. This can lead to falls, fractures and secondary injuries.
Here, physical therapists have you move your lower limb joints through various movements to practice movement patterns and retrain the nerves.[xiii]
This could mean toe raises, moving your foot up, down, inwards and outwards to retrain ankle ROM and performing wall slides and so on.[xiv]
Progression includes performing the exercises first on both legs, then on a single leg and then increasing difficulty by placing obstacles in the path or changing the walking surface.
3. Scar Tissue Mobilizations with Massage
Scar tissues can form either on the outside or the inside of your body as a result of surgery or injury. If these are not remodeled properly then you could suffer from restricted movements and pain.
Physical therapists use cross friction massage, soft tissue massage and lymphatic massage to mobilize scar tissues in cancer patients to get these tissues to tolerate the stress of movements.
These treatments tend to break up the adhesions and promote healing while restoring flexibility.
Your physical therapist may use moisturizing creams or compression garments as aids for the healing process.
4. Aerobic Training
Aerobic training helps increase your endurance and this can significantly improve your quality of life. It’s divided into cardiovascular rehab and pulmonary rehab.
Lung cancer patients have frequent episodes of breathlessness; others suffer from lung damage due to radiation.[xv] Lung problems are also a significant postoperative complication even for non-cancer patients.
All this leads to reduced oxygen in your blood and requires extra effort to breathe while exercising or even while moving around for daily activities. That’s why pulmonary rehab can make a huge difference for most cancer patients.
Here, you learn breathing strategies and perform various exercises with regular strategic progression to improve your lung capacity and cardiac health.
Lai et al. (2017) found that a preoperative pulmonary rehab program for lobectomy (surgery to remove a lobe of the lung) patients can have a positive impact in reducing the post-surgical side effects.
5. Education
Education is as important in PT treatment as any other therapy approach we use here. Your physical therapist will educate you on your condition, the side effects, potential recovery window and such topics.
We also inform the patients about the warning signs and teach them home exercises to keep the rehab going after their discharge from the hospital.
Educating the patient also has some indirect benefits.
By learning about the disease conditions and the role of exercise, patients tend to understand much better the impact of their active participation on their recovery. It can also increase compliance with the plan of care.[xvi]
Oncologic Physical Therapy – In a Nutshell
The treatment approaches covered here only scratch the surface of what we do in Oncologic Physical Therapy. Other treatments include strength training, joint mobilizations, treating neuropathy, pelvic floor rehab and so many more.
Oncologic Physical Therapy is starting to get the attention it deserves, but we are not quite there yet.
Many cancer patients suffer from a decreased quality of life because of a lack of proper treatments for their issues.
The treatments we use here are individualized for specific patients. You can do most of the exercises yourself. But it’s best to get a physical therapist or a doctor to approve your exercises before you begin.
If you’re undergoing chemotherapy or radiation therapy or even if you’re in remission and looking to improve your functional mobility, then contact a physical therapist so you can get the help you need.
[i] https://europepmc.org/article/med/28251254
[ii] https://agsjournals.onlinelibrary.wiley.com/doi/abs/10.1111/jgs.15930
[iii] https://link.springer.com/article/10.1186/s12885-019-6310-0
[iv] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3267760/
[v] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3253916/
[vi] https://link.springer.com/article/10.1007/s10585-018-9899-5
[vii] https://link.springer.com/article/10.1007/s11884-019-00517-8
[viii] https://www.frontiersin.org/articles/10.3389/fonc.2018.00145/full
[ix] https://www.mdpi.com/1422-0067/20/6/1451
[x] https://link.springer.com/article/10.1007/s00520-018-4318-7
[xi] https://www.youtube.com/watch?v=C3kn2LZL__E&t=522s
[xii] https://www.sciencedirect.com/science/article/abs/pii/S0749208116300808
[xiii] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5852220/
[xiv] https://www.youtube.com/watch?v=Jv__41ctwp8
[xv] https://onlinelibrary.wiley.com/doi/full/10.1111/1759-7714.12466